title: A kink is not always a perforation: assessing Essure hysteroscopic sterilization placement.
abstract: OBJECTIVE
  To highlight the fallacy of using a kink in the microinsert outline on plain abdominal x-ray as a marker for tubal perforation.
  
  
  METHODS
  Case report.
  
  
  METHODS
  West London District general hospital.
  
  
  METHODS
  36-year-old Asian woman requesting permanent sterilization.
  
  
  METHODS
  Essure hysteroscopic sterilization followed by abdominal x-ray, pelvic ultrasound, and laparoscopy.
  
  
  METHODS
  Absence of tubal perforation.
  
  
  RESULTS
  A patient presented with clinically suspected fallopian tube perforation 3 days after Essure hysteroscopic sterilization. Her transvaginal scan was inconclusive, but the plain x-ray demonstrated a kink within the left microinsert outline. Diagnostic laparoscopy did not identify a perforation, and bilateral tubal placement was confirmed after salpingectomy.
  
  
  CONCLUSIONS
  This case highlights the difficulty of relying on imaging in the acute setting to establish a diagnosis of tubal perforation after hysteroscopic sterilization.
authors.affiliation: Department of Obstetrics and Gynaecology, Ealing Hospital NHS Trust, London, United Kingdom. janeborley@yahoo.co.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Borley
authors.forename: Natasha
authors.initials: N
authors.lastname: Shabajee
authors.forename: Toh Lick
authors.initials: TL
authors.lastname: Tan
mesh_terms: D000328:Adult; D020878:Device Removal; D003951:Diagnostic Errors / Q000517:prevention & control; D004867:Equipment Design; D005187:Fallopian Tubes / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000295:instrumentation*; D007434:Intrauterine Devices; D010535:Laparoscopy; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011237:Predictive Value of Tests; D011860:Radiography, Abdominal; D012086:Reoperation; D012421:Rupture; D058994:Salpingectomy; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography